Provider First Line Business Practice Location Address:
5001 N KINGS HWY STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MYRTLE BEACH
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29577-2556
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-692-2555
Provider Business Practice Location Address Fax Number:
843-692-9976
Provider Enumeration Date:
08/12/2006